With this Bulletin, the Financial Services Commission of Ontario (FSCO) is highlighting recent automobile insurance amendments, providing clarification regarding caps applicable to the costs of assessments and examinations under the Statutory Accident Benefits Schedule – Effective September 1, 2010 (SABS), and releasing the following:
- New Professional Services Guideline
- Amended Settlement Disclosure Notice (SDN)
- Amended Application for Accident Benefits (OCF-1)
Automobile Insurance Amendments
In the 2011 Ontario Budget, the Government made a commitment to build on the September 2010 auto insurance reforms by taking further steps to reduce fraud. These steps include introducing new rules to ensure that treatments are provided as invoiced. Further, the Insurance Act was amended to help municipal transit systems control fraudulent claims.
As a result, the Government has recently passed the following regulation and legislation changes:
Statutory Accident Benefits Schedule – Effective September 1, 2010
O. Reg. 194/11, filed on Friday, June 3, 2011, amends the SABS to include provisions (ss. 46.1, 46.2 and 55) that enhance the ability of insurers to seek verification of invoices received for goods and services provided to claimants.
The amendments come into force on July 1, 2011.
Bill 173, the Better Tomorrow for Ontario Act (Budget Measures), 2011, came into force on May 12, 2011. Schedule 21 of Bill 173 made the following amendments to the Insurance Act, applicable to accidents that occur on or after May 12, 2011:
- s. 267.5 (6.1) of the Insurance Act now provides that subsections (1), (3) and (5) do not protect the owner or driver of a public transit vehicle from liability for damages for negligence if the public transit vehicle did not collide with another automobile or any other object.
- s. 268 (1.1) of the Insurance Act now provides that no statutory accident benefits are payable from any source to an occupant of a public transit vehicle if the public transit vehicle did not collide with another automobile or object.
Professional Services Guideline
The new Professional Services Guideline (Guideline) released with this Bulletin increases the maximum hourly rates by 1.8 per cent. This increase is based on the 2010 Consumer Price Index (CPI) and applies to services rendered on or after July1,2011.
Services rendered prior to July 1, 2011
The Superintendent’s Professional Services Guideline No. 06/10 continues to apply to expenses related to services rendered between September 1, 2010 and June 30, 2011, whether they are billed before or after July 1, 2011.
Clarification Regarding Caps on Costs of Assessments and Examinations
The new Guideline provides that:
- The $200 maximum fee for a Treatment and Assessment Plan (OCF-18) applies only to the services of a health practitioner as referred to in subsection 25 (1) 3 of the SABS, namely reviewing and approving an OCF-18 under subsection 38(3)(c), including any assessment or examination necessary for the purpose of that review and approval by the health practitioner. The $200 maximum fee does not apply to assessments or examinations that are proposed in an OCF-18 and that an insurer agrees to pay for under subsection 38(8).
- Although the SABS does not expressly set out the criteria an insurer is to apply in determining whether or not to agree to pay for a proposed assessment or examination under subsection 38(8), an insurer should not act arbitrarily or fetter its discretion, but should instead consider each proposed assessment or examination on its merits with regard to the insurer’s obligation to adjust and settle claims fairly and without unreasonable delay or resistance.
- As provided in subsection 25 (5) (a) of the SABS, an insurer may agree under subsection 38(8) to pay fees of up to $2,000 for any one assessment or examination proposed in an OCF-18.
With this Bulletin, FSCO is releasing amended versions of the Application for Accident Benefits (OCF-1) and the Settlement Disclosure Notice (SDN), to reflect minor corrections since the September 1, 2010 release. These amended forms are approved for use effective July 1, 2011. Earlier versions of the forms are not approved for use after July 1, 2011.
The amended forms and the new Guideline are attached for your information and can also be downloaded from the FSCO website at www.fsco.gov.on.ca. In addition, the Guideline and O. Reg. 194/11 will be published in a forthcoming edition of The Ontario Gazette.
Chief Executive Officer and
Superintendent of Financial Services
June 14, 2011
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